There are a few nice things(trying to find a silver lining) about Covid-land: traffic, our lives are sometimes simpler, much less scheduled, more laid back. Of course, many more bad things but…. We learn new things daily: 1. you should have a pulse oximeter available, in case of symptoms: turns out, people sometimes are not very short of breath despite low oxygen levels(there are some conditions that cause this, but not too many; usually, if oxygen is lower than 94 or, certainly 90, people struggle with breathing, but not so with this virus). So, people may be sick with fever, chills, aches, fatigue; tooling around, not too short of breath; then, all of a sudden they crash(and sometimes die). If you measure your oxygen levels, and the level drops below 95, or 94, then call the doctor or go to the hospital. Your hands should be on the warm side to accurately measure the oxygen levels(too cold=artificially low readings, by a point or 2 or 3). Usually the index finger is used, but thumbs work well.
We are hearing about various neurologic manifestations of Covid; the common effect of loss of smell is actually(sort of) neurologic. Strokes are somewhat common, probably due to the increased incidence of blood clots. For ICU patients, delirium is common; there have also been some instances of Covid encephalopathy(the virus causes brain dysfunction in these cases).
Also, if you do have symptoms, breathe deeply every 3 or 4 hours; a blow-up pool plastic type toy can help with this. Whether ibuprofen(or other nsaids) are truly contraindicated is still up in the air.
I am going to have residents and students from Loretto hospital(to teach neurology)…am looking forward to the psych residents. Loretto is an inner city Chicago hospital; they are taking Covid precautions ultra-seriously(the virus has a much higher mortality for black and hispanic patients: a number of reasons for this.) I may go to work in the hospital, depending upon how much Chicago gets hit in the upcoming weeks(so far it is a bit less than expected: McCormick place has been adapted to have many Covid patients, but thus far has not been needed, which is great)….
We are doing mostly phone consults, altho people come in for Botox and labs, acupuncture, SPG nasal sprays, some Ketamine etc; but 90% on the phone, which works fine. I actually think the phone consults are more laid back: if a person has 8 issues, I can get to all 8, in a more relaxed fashion. Or, say someone has new onset depression(happens frequently): I can get the history on the phone, and then talk with a significant other(mom, boyfriend etc..)…If we DON’T talk with a significant other person, we miss 40% of “hypomanias”, and are apt to under diagnose the “mild end” of the bipolar spectrum(gosh, I wish they would change the name of “bipolar’ to something less pejorative)….the “clinical stakes” for missing the mild end of the bipolar spectrum are enormous: people keep bounding around on antidepressants, which either:1. don’t work, or 2. give the “bipolar opposite” reaction: up all night, wired, mind racing. Experts estimate that a good 55 to 60% of adults with chronic depression fit the bipolar spectrum. We want to use mood stabilizers, not antidepressants. More on: the soft signs/soft end of the bipolar spectrum, and mood stabilizers, later on….
Post-Covid: life will be different. How so, not sure. In the medical arena, some smaller offices are either closing, or selling to big medical systems. Many hospital personnel will have PTSD, and need medications, psychotherapy, and time off; some will never return to working.
I am trying to stay optimistic: there are best case scenarios(a vaccine sooner than later, herd immunity sooner than later, a treatment…); worst case scenarios(no vaccine, horrific 2nd or 3rd waves, or: worst worst case: a new pandemic on top of this, or this virus mutates in a more dangerous way(unlikely: most mutations do not affect it’s effect, or render it less serious)…….
Ciao and adios for now…..
Larry Robbins,M.D.

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